Healthcare Provider Details

I. General information

NPI: 1134122435
Provider Name (Legal Business Name): ALAN TODD ISRAEL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 N PEACH AVE STE E5
CLOVIS CA
93611-7252
US

IV. Provider business mailing address

755 N PEACH AVE STE E5
CLOVIS CA
93611-7252
US

V. Phone/Fax

Practice location:
  • Phone: 559-283-9571
  • Fax:
Mailing address:
  • Phone: 559-283-9571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11852
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT11852TPA
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: